Patient: 35-year-old man Chief Complaint: Blurred vision and floaters in the left eye History of Present Illness: The patient presents with a 2-week history of progressive blurred vision and floaters in his left eye. He also reports mild photophobia but denies pain or redness. He has a history of HIV/AIDS and admits to poor adherence to antiretroviral therapy. He denies any recent trauma or foreign body exposure to the eye. There is no history of similar symptoms in the past. Past Medical History: HIV/AIDS diagnosed 5 years ago History of opportunistic infections, including oral candidiasis Last CD4 count: 45 cells/µL (checked 3 months ago) Viral load: Elevated (>200,000 copies/mL) Medications: Intermittent use of antiretroviral therapy (ART) No current opportunistic infection prophylaxis Social History: Non-smoker, occasional alcohol use No recreational drug use Review of Systems: No headache, fever, or seizures No weight loss or night sweats.Physical Examination: General: Alert and oriented, no systemic signs of infection Left eye examination: Decreased visual acuity (20/100 in the left eye, 20/20 in the right eye) Conjunctiva and cornea: Normal Fundoscopic exam: Yellow-white, fluffy retinal lesions with surrounding retinal edema Vitritis causing a “headlight in the fog” appearance No retinal hemorrhages Right eye: Normal findings Diagnostic Workup: Fundoscopy: Yellow-white chorioretinal lesions confirm suspicion of chorioretinitis. Serology: Positive Toxoplasma gondii IgG Negative Toxoplasma gondii IgM (suggests reactivation, not new infection) PCR testing on aqueous humor: Positive for Toxoplasma DNA CD4 count: 38 cells/µL (confirmed low) Question: What is the most appropriate treatment for this patient?
